Card 3
Card 3
nd hardening. Lateral traction increased, hard to expand ● 100% O2 in a shunt? Hb carries most O2 and is almost fully saturated already; 100% O2
Intraplural P (Pip)– made less negative (more +) by ↓ lung elasticity. lungs would result in a small amount of O2 to Hb, contributes nothing to shunted venous
Intrapulmonary pressure = alveolar pressure (Palv) Bronchitis= inflammation of bronchioles but have the same compliance as a regular person blood, PO2 would rise, but content would change only slightly
TPP (trans pulmonary pressure) = distending pressure (hold open) TPP= P(alv)– P(ip) @ high altitudes - ↓O2 (hypoxia) so ↑ Ventilation ↓pCO2 (alv) ● Diffusion Impairment: between alveoli and capillaries; alveolar gas and capillary blood do
Airway Structure: trachea-bronchi-bronchioles-elastin+some cartilage in framework gives - Airflow ventilation Pgas = F% x Ptotal not equilibrate; PaO2 falls and PAO2 remains normal; caused by Diffuse Interstitial
elastic properties and recoil force to keep airways open, but can collapse. Top ↓V,perf,C ↑V/Q, >1 ↓Q ↑TPP ↑O2 fibrosis, asbestosis, fluid build up/thickening of alveolar walls caused pneumonia; can
Inspiration: external intercoastals up & out, diaphragm pulls down. IP space remains the Bottom ↑V,perf,C ↓V/Q, <1 ↑Q ↓TPP ↓CO2 give 100% O2 to try and push O2 into perfusion
same (closed container) (P1V1 = P2V2) - As you go up the lung V/Q goes up, bc Q goes down rapidly ● Elite athletes – huge CO – short transit time of blood through capillaries – blood not fully
Pressure changes during inspiration – pre-inspiration TPP = 0 - -5 = +5; during -2 - -8 = +6; - Q blocked – alv air is comp of inspired air. oxygenated – PcO2 down and widened Δ(A-aO2)
end inspiration 0 - -9 =+9; mid expiration 2 - -4 = +6 Fick’s Law of Diffusion = Vgasdiffused = DxSAx(P1-P2)/T D=diffusability, SA=surface area, ● SUMMARY: Hypoxemia causes: decreased PlO2, Hypoventilation, Ventilation/Perfusion
Expiration – passive, no muscle needed. Palv > Pout, so air flows out. Everything returns to T=distance mismatch, Shunt right-left, Diffusion impairment
original dimensions. O2 diffuses through surfactant layer, alveolar epithelium, interstitium, pulmonary capillary ● Gravity: gradient in ventilation+perfusion (low apex, high bottom); gradient for perfusion
Pneumothorax – collapsed lung; Patm>Pip normally; hole in IP space cause Pip=Patm; chest epithelium, plasma, and RBC membrane is steeper (high apex, low bottom), Va/Q=0 poor ventilation, Poor perfusion Va/Q
wall expands outward, lung recoils inward; negative pressure in IP space made less negative Solubility – CO2 much higher, small pressure difference; opposite for O2; lots of CO2 after =infinity
at FRC decreasing inward recoil force of lung – age, emphysema alveolar gas exchange (bicarb, pH balance) TRANSPORT OF O2 AND CO2 O2 40mmhg->100 CO2 46mmHg->40mmHg
Compliance C = ΔV/TPP (Δtpp needed to ↑ lung volume.) ↑C easier to expand lungs at any Perfusion limited = gas exchange dependent on blood flow; 0.75 second in capillary ~2-3 21% O2, 79% N2, .02-.03% co2 1atm=760mmhg PH2O @37C: 47mmHg
given P. (↑blood Vol, edema, hyaline membrane disease=↓C). stronger recoil forces = lower alveoli, O2 equilibrates in <0.3 sec; x2 blood flow, perfusion time 0.375s, all blood would still Gas phase-pp proportional to conc. Po2=Pb x Fo2. Liquid phase-pp at which liquid neither
compliance. Emphysema & age ↑ C equilibrate gives up nor takes up the gas.
Elasticity (collagen and elastin) & Surface tension contribute to lung recoil. NOT diffusion limited = blood would not equilibrate during time it is in alveoli - Henry’s law - amount of gas dissolved in art blood = Pgas x Solub Coef
Surfactant: phosphatidylcholine + surfactant proteins (spABCD), 26 weeks after gestation, Hypoxemia = low PaO2 Solubility coeff= O2 ( .003) Co2 (.075), N2 (.0017). ↑T=↓solub.
secreted by alveolar type2cells Decrease in PO2; high altitude %O2 stays same but PO2↓, breath more or hypoxemia Plasma & blood same PO2. More O2 in blood bc is bound to Hb.
La Places Law: P=2T/radius T=tension P= required to keep alveoli open. ● Hypoventilation; ↓VA, VO2 same or increased; PAO2↓ and PaO2↓; usually happens 15g Hb/100 mL of blood, 1 g can bind 1.34 mL = 21 mL O2 bound
Infant Respiratory Distress – lowers compliance, born without surfactant, lungs usually peripheral to lungs; neuromuscular diorders, narcotics, lungs normal >↑ altitudes, ↓PO2 - ↓ ability of Hb to be sat. (~60-80 mmHg)
collapse; synthetic surfactant, treat mom with cortisol, CPAP, mechanical ventilation ● Gravity: More negative intrapleural pressure (Pip) at lung apex; gradient from top to anemic - ↓ amount of Hb hence ↓amount of O2 in the blood. Saturation is not affected, PO2
Resistance: 20-25% in upper nasal. Greatest resistance in bronchial tree is medium sized bottom; gradient in alveolar distending pressure; A=alveolar, a=arterial is the same.
th
bronchiole 7 generation. Airways in parallel. 1/Rt. Affected by TPP, and lateral traction. ● APEX = alveoli more distended, larger alveoli, less compliant In lungs-HbO2 stronger acid than deoxy, gives up proton, combining with hco-3 going
Palv −Patm ● Inspiration: ↓Pip, greatest volume increase in most compliant alveoli/bottom opposite direction. In tissues Haldane affect, deoxy picks up H+ produced from dissociated
● Every cm. above heart = 1 cm H2O decrease in hydrostatic pressure bicarb. For every mmol of O2 used, 0.7 mmol Co2 produced. lungs & kidneys play role in acid
● ↓P – less distended - ↓r – increase Resistance - ↓Q; ↓Q at apex vs. ↑Q at bottom of lung base regulation.
Poiseullie eqt: F= = ΔP/R. R α viscocity of air, -p50 of fetal is 15-20mmhg
● Gradient in perfusion, gradient in ventilation = both low at apex, high at bottom
receptors trigger for pain, ⇑ sympathetic firing. Both prevent blood loss while clotting occurs
| Hemopexin binds heme from MetHb in intravascular hemolysis HEMOSTASIS 1) Vasoconstriction - Myogenic vasospasm: in SM of vessel. Neurogenic
● Anemia: low RBC count/low O2 (low Hb); 1)not making enough RBCs = hypoproliferative
(low [Fe2+], blood loss, prolonged inflammation, renal diasease.) 2) Breaking RBC down too (20 mins). Humoral Responses: released locally to vasoconstrict (hours). Form platelets in
fast (hemolytic events, bone marrow destruction/thalassemia); pernicious anemia = low “release rxn”. Serotonin,ThromboxaneA2(derived from pl), ProGlanF, ADP
B12 due to lack of absorption need; intrinsic factor=lowered, causes B12 to be lowered); 2) Form platelet plug: contact of blood with CT. Platelets don’t stick to endothelial, bind to
examples include hereditary spherocytosis [spherical], sickle cell anemia, hereditary G6P subendothelial collagen → platelet adhesion. “Release Reaction”, release Ca, serotonin &
deficiency. (reduces ability of oxidation. ADP. Platelet Aggregation: binding of platelet to platelet. High ADP & TA2 help clumping.
● B12 & folic acid needed for biosynth, prolif occurs in marrow. Platelet membrane phospholipid acted on by enzymes to produce TA2, which promotes
● Increase # RBCs: 1)Increase size of erythroid marrow compartment/total # of erythrocyte aggregation (humoral vasoconstrictor). Prostacyclin (PGI2): inhibitor of aggregation in
precursors 2)Increase in rate of maturation of erythrocyte precursors surround endothelial cells, prevents platelet aggregation from extending away from injury.
● Hemoglobin Synthesis: globin in ribosome. heme = porphyrin ring containing Fe2+;, Cyclo-oxygenase: enzyme involved in producing TA2. Aspirin acetylates & inactivates this
mitochondria make heme iron comes from transferrin. ( degraded RBC, body stores, & enzyme irreversibly, ↑bleeding. Von Willebrand Factor: bind onto subendothelial collagen,
dietary from GI) storage form contains of metal ion bound to ferritin or hemosiderin. required for platelets to bind to collagen (adhesion), required to maintain function of CF VIII.
● Blood Typing: Type A has anti-B Abs, Type B has anti-A Abs, type AB has no Abs, type O has Constriction & plug= primary hemostasis
all Abs; O=universal donor, AB =universal recipient; Abs don’t go with transfusion; Rh- mom Hemophilia: can’t coagulate, no secondary., Type A: CF8 (most common), Type B: CF9,
and Rh+ baby=first baby ok, second baby not because mom has Anti-D Abs = Christmas.
erythroblastosis fetalis; treat with injection of Anti-D Abs into mom (RHOGAN) > With Ca, prothrombin → thrombin by thromboplastins released from damaged
● Hb Fate: see pic.; RBC broken into AA’s and heme; AA’s recycled; Heme breaks into tissues/platelets release rxn. Thrombrin activates Fibrinogen → fibrin clot. Held together by
porphyrin and Fe2+; porphyrin broken into biliribun and CO (CO exhaled), biliribun to weak non-covalent forces then crosslink covalent bonds (Fibrin Stabilizing Factor, CF XIII).
albumin to liver and conjugated with glucoronic acid to form bile, excreted to gut and feces - Intrinsic Pathway. – factors found in blood. Contact-activation system. XIII starts clotting
(jaundice =build up of bile); Fe2+ bound to plasma transferrin and goes to bone marrow cascade, amplifies signal pathway. Activates prothrombin→thrombin (which activates
@ tissues: O2 out, HCO3 out, Cl in, H20 in, CO2 into cell fibrinogen). Platelet phospolipid (PF3) is template for 8 & 9 to activate X.
- Kidney regulation–monitor production rate,↓pO2, ↑erythropoietin/hb - Extrinsic Pathway. Req from tissue trauma → Tissue Thromboplastin (protein +
α and β globin are synthesized on ribosomes in cytosol of normoblast. The prophyrin group phospholipid) CF VII, 7 →activates CX to activate prothrombin. VIIa activates X with Ca and
of heme is synthesized in the mitochondria of this cell phospholipid – positive feedback Xa is able to activate more VII. Calcium- -carboxyglutamic
Intravascular Hemolysis- destruction of freely circulating blood cells, due to transfusion acid: critical for Ca binding to CFs. Vitamin K requ for carboxylation to form y-
reactions or Rh-incompatibility, decrease hapatoglobin levels carboxyglutamic acid from glu. No Vit K →no y-carboxyglutamic acid →no Ca binding
Extravascular hemolysis -RBC Lysis (@spleen) . in free circulation→ Hb – dimers bind to factors→ no coagulation. Coumarin,Warfarin (anti-coagulant): blocks enzymatic addition of
hepatoglobin - @ reticulo-endothilial (liver) lysed to form aa (↓hapto – Hb in urine); Fe – carboxylates.: